Tendon pain is the most common gradual-onset, overloading injury. Mechanotherapy / exercise is the most beneficial treatment option.
Eccentric exercises have been commonly prescribed over the last decade, following the pain-provoking Alfredson programme of 3 x 15 reps, twice/day. It sometimes works very well. The last few years I’ve favoured isometric exercise as an initial treatment - partly because of personal experience with Achilles, patellar, and lateral elbow tendon issues, & recommendation from Jill Cook & Craig Purdham at the AIS.
New research adds some support to isometric exercise as a treatment for tendinopathy, concluding it reduces tendon pain and improves strength. The authors delve in to all the “hows” & “whys” of how it works in their discussion, and to be honest it’s a bit technical for my understanding.
The research protocol uses 5 reps of a 45 second contraction, at a 70% effort. I prefer a more gentle contraction of 50% effort, but a longer hold of at least a minute, and I like a larger total volume of at least 10 minutes/day. Obviously it’s hard to define what the perfect dosage is for exercise, & volume could be adjusted depending on results. I like isometrics because:
40 Comments
Robert
14/5/2016 02:14:07 pm
I was looking to incorporate isometrics in rehab for my brachialis issue from bouldering/rock climbing. I was wondering about suggestions for sets/repetitions and frequency, I wanted to try isometric pullups (hanging at 90 degrees at the elbow), along with static stretches.
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Fergus
14/5/2016 07:41:43 pm
I wouldn't recommend static stretching. In most cases it seems to be aggravating.
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Robert
16/5/2016 02:39:45 pm
I feel 3x30 twice a day is most suitable since I'm doing static holds with my whole bodyweight. Do you think I need to find a way to lessen the load on my arms somehow and do longer holds?
Robert
16/5/2016 02:48:20 pm
And also, I would appreciate input on whether or not there's need for a warmup for this sort of rehabilitative isometrics, and your opinion on rest periods between sets.
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Robert
17/5/2016 08:43:11 am
Thank you so much for the help! So far it feels good, and I am looking forward to seeing the long term effects.
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Layya Halawi
21/4/2018 10:58:54 pm
Hello Robert,
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Anita Stack
4/6/2016 05:13:55 pm
Hi I have recently ben told I have Tendinopathy of the Gluteus Medius. I have just read your description of Isometric exercises being a good way to start to help the problem. Can you give me some examples of what I could do. I have visited a local physio who gave me one exercise but wants me re visit to get the next one which is costly and time consuming for me.
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steve
28/9/2016 06:31:38 pm
Really eye-opening...
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G'day Steve,
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steve
3/11/2016 07:54:48 am
Thank you so much for you reply...
Fergus
3/11/2016 08:36:42 am
Steve, yes I would work around it rather than push through it. That may mean dropping weight 25% or swapping for an exercise with different grip. Anything that doesn't hurt.
Layya
21/4/2018 11:15:55 pm
Thanks for all these tips. For the "isometric anterior straight-arm fly", I need to have my arms straight at 90 degrees to my body or lower or it doesn't matter?
Layya
21/4/2018 11:05:06 pm
Hi Steve,
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Margaret
28/12/2016 04:30:43 am
Hi. Appreciate your blog very much. Female age 60, with "medium" grade muscle-tendon tear. Therapist has me doing buttock squeezes, bridges, and sit-to-stand exercises mostly. 10 reps twice a day. Pain and walking only ever so slightly better. Still hurts standing on one leg, and walking still hurts, also have lost quite a bit of range of motion in my hip. These exercises seem to be about all I can tolerate but I don't see much improvement after two months. Also wall presses, but I do those while standing on good side which I think activates glute med in unaffected side only. Not sure why therapist has me do that. What else can I do to improve?
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FERGUS
28/12/2016 09:06:40 am
Hi Margaret,
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Margaret
28/12/2016 01:15:03 pm
Oh ,so sorry ! Yes, gluteus medius tear, at point of tendon I assume. Unfortunately, misdiagnosed for over a year as lower back pain and hip bursitis, so I was doing my normal walking exercise until I couldn't stand it any more. Gave up my beloved walks months ago as the pain was so bad, but I should start back gently. I like your suggestions of isometric exercises, and the pillow between leg which probably helps lessen compression on the tendon (?) or lessens pulling on tendon (?) so I will give them a go. I miss walking so much. And interestingly, I weigh 10 -15 lbs more than I should. It makes sense that extra weight isn't good in this situation, so clearly this is motivation to lose weight. Appreciate the feedback greatly. Thank you!
Liv abbott
2/1/2017 10:12:46 pm
Could this same protocol be used for obturator internus pain and tedinopathy? Thank you
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Fergus
3/1/2017 07:52:13 am
Hi Liv, Absolutely.
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Liv abbott
3/1/2017 08:56:20 am
Thank you! How long does it 'normally' take for pain to resolve? So I can manage my expectations ha
Fergus
3/1/2017 09:00:43 am
I would it expect isometrics to noticeably give you pain relief on the first day. Definitely much better within a couple of weeks, depending on how diligent you are at getting it done. If it's not "working" I'd change the direction of force or re-look at the diagnosis.
Ad
12/5/2017 10:57:29 pm
I had tendinopathy in one of my rotator cuffs and long head of the bisceps in my left shoulder. After months of physio treatment my physiotherapist set me up with one of the leading sports medicine doctors in toronto to get prp injections. That was about 5 or 6 years ago. It worked great. I am painfree and able to do everything i use to do. That was my experience.
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Steve
9/7/2017 01:27:45 am
Hi
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FERGUS
9/7/2017 12:16:44 pm
Hi Steve,
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Justin's D.
4/8/2017 09:40:44 am
Hi,
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Ferg
4/8/2017 10:45:49 am
Hi Justin,
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Tim
16/8/2017 07:29:13 am
Hello,
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Ferg
16/8/2017 10:28:21 am
G'day Tim,
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Rich
29/1/2018 01:59:08 pm
hi,
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Ferg
30/1/2018 02:48:43 pm
Hi Rich,
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Rich
30/1/2018 03:48:54 pm
thanks for the reply, if it hurts after i do the exercises is that ok?
Ferg
30/1/2018 04:07:48 pm
I would expect some soreness during the hold, but not immediately after. Soreness later in the day means something else is overloading it, and I'd look to modify whatever other activity it is that's aggravating.
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Rich
1/2/2018 11:52:05 am
Hi Fregus,
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Ferg
1/2/2018 12:36:29 pm
I'd look for a level of resistance that is sore to hold, but not sore after.
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Jon
14/10/2018 02:00:38 am
I had a sports hernia that was repaired earlier this year along with adductor tendinopathy. My abdominal symptoms were fixed with the surgery but unfortunately the adductor did not. I then had an adductor tenotomy which definitely cut away a lot of scarred tendon tissue but unfortunately I still get discomfort at the pubic tubercle region right where the adductor tendon inserts with adduction movements. I had the adductor surgery in May. I'm trying to do isometric ball between my knee holds? Is this the correct protocol?
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DEBBY Bosch
26/6/2020 03:34:55 am
I’m 5 months THR post op and have chronic gluteus medius tendinopathy. Is it normal not to be able to walk for more than 30 steps without pain? I am doing isometric exercises for just over two weeks with no improvement yet. I can’t get past 25 second holds. As soon as I do, I am back to where I started.
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